IntroductionPropofol-based sedation for gastroscopy is effective but may cause dose-dependent cardiorespiratory depression; therefore, optimizing adjunct strategies to reduce propofol exposure is clinically important.MethodsWe conducted a prospective, single-center, randomized, double-blind, dose-response trial to evaluate the propofol-sparing effect of remimazolam during procedural sedation for gastroscopy. A total of 150 ASA I-II adults aged 18–59 years were randomly assigned to receive remimazolam 0, 0.05, 0.1, 0.15, or 0.2 mg·kg−1, and propofol was titrated to achieve adequate sedation. The primary outcomes were the propofol effect-site EC50 and propofol requirement (mg·kg−1·min−1). Secondary outcomes included recovery profiles, post-anesthesia care unit (PACU) duration, and sedation-related adverse events.ResultsRemimazolam reduced the propofol EC50 in a dose-dependent manner, from 3.05 (95% CI, 2.88–3.21) μg·mL−1 at 0.05 mg·kg−1 to 1.47 (95% CI, 1.30–1.64) μg·mL−1 at 0.2 mg·kg−1, and decreased propofol requirement from 0.587 ± 0.193 mg·kg−1·min−1 in the control group to 0.414 ± 0.121 mg·kg−1·min−1 at 0.1 mg·kg−1 and 0.298 ± 0.088 mg·kg−1·min−1 at 0.2 mg·kg−1. Procedure duration and PACU duration did not differ significantly among groups, and the incidence of sedation-related adverse events was comparable.DiscussionAdjunctive remimazolam provided a dose-dependent propofol-sparing effect during gastroscopy sedation. Among the tested doses, 0.1 mg·kg−1 appeared to offer a favorable balance between reduced propofol requirement and recovery profile, supporting its clinical feasibility under the conditions studied.Clinical Trial RegistrationChinese Clinical Trial Registry, identifier ChiCTR2400094449.
Zhang et al. (Wed,) studied this question.